The effect of a combined intervention on exclusive breastfeeding in primiparas: A randomised controlled trial
Drita Puharić, Mario Malički, Josip Anđelo Borovac, Vladimir Šparac, Boris Poljak, Nađa Aračić, Nero Marinović, Nives Luetić, Irena Zakarija-Grković, Drita Puharić, Mario Malički, Josip Anđelo Borovac, Vladimir Šparac, Boris Poljak, Nađa Aračić, Nero Marinović, Nives Luetić, Irena Zakarija-Grković
Abstract
An antenatal/postnatal intervention involving proactive telephone support and written materials was conducted among primiparas. Four hundred women, from the Split-Dalmatia County, Croatia, were randomized between November 2013 and December 2016 into three groups: intervention (IG), active control (ACG) and standard care (SCG). Primary outcome was exclusive breastfeeding (EBF) at 3 months. Secondary outcomes included breastfeeding difficulties, attitudes towards infant feeding, breastfeeding self-efficacy and social support. Practice staff were blinded to group allocation. Of 400 women, 45 (11%) were lost to follow-up, and final analyses were conducted on 129 (IG), 103 (ACG) and 123 (SCG) participants. EBF rates at 3 months were significantly higher for the IG (odds ratio [OR] 4.6, 95% confidence interval [CI], 2.7 to 8.1; EBF 81%) as well as at 6 months (OR 15.7, 95% CI, 9.1 to 27.1; EBF 64%) compared with SCG (EBF 47% at 3 months and 3% at 6 months). Higher rates were also observed for the ACG at 3 months (OR 2.2, 95% CI, 1.3 to 3.8, EBF 68%) and 6 months (OR 2.3, 95% CI, 1.4 to 3.9, EBF 16%). Participants in the IG had the highest increase in positive attitudes towards infant feeding, in comparison to baseline, and significantly higher breastfeeding self-efficacy. Participants in SCG experienced significantly more breastfeeding difficulties, both at 3 and 6 months, in comparison to AC and IGs. Written breastfeeding materials and proactive telephone support among primiparas are an effective means of increasing breastfeeding rates, decreasing breastfeeding difficulties and improving self-efficacy and attitudes towards infant feeding.
Trial registration: ClinicalTrials.gov NCT01998087.
Keywords: RCT; antenatal/postnatal intervention; breastfeeding; exclusive breastfeeding; first-time mothers; proactive telephone support.
Conflict of interest statement
The authors declare that they have no conflicts of interest.
© 2020 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.
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References
- Balogun, O. O. , O'Sullivan, E. J. , McFadden, A. , Ota, E. , Gavine, A. , Garner, C. D. , & MacGillivray, S. (2016). Interventions for promoting the initiation of breastfeeding. Cochrane Database of Systematic Reviews, 7, CD001688 10.1002/14651858.CD001688.pub3
- De La Mora, A. , Russell, D. W. , Dungy, C. I. , Losch, M. , & Dusdieker, L. (1999). The Iowa infant feeding attitude scale: analysis of reliability and validity. Journal of Applied Social Psychology, 29(11), 2362–2380. 10.1111/j.1559-1816.1999.tb00115.x
- EU . (2008). Project on promotion of breastfeeding in Europe. Protection, promotion and support of breastfeeding in Europe: A blueprint for action (revised). European Commission, Directorate Public Health and Risk Assessment, Luxembourg, 2008.
- Hudek‐Knežević, J. (1994). Coping with stressful situations of conflict between professional and family role. Dissertation Zagreb: University of Zagreb.
- Lavender, T. , Richens, Y. , Milan, S. J. , Smyth, R. M. , & Dowswell, T. (2013). Telephone support for women during pregnancy and the first six weeks postpartum. Cochrane Database of Systematic Reviews, 7, CD009338 10.1002/14651858.CD009338
- Marinović Guić, M. (2007). Stavovi trudnica prema dojenju; Korelacija sa započinjanjem i duljinom dojenja nakon poroda. Magistarski rad Split: School of Medicine University of Split.
- McFadden, A. , Gavine, A. , Renfrew, M. J. , Wade, A. , Buchanan, P. , Taylor, J. L. , & MacGillivray, S. (2017). Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews, 2, CD001141 10.1002/14651858.CD001141.pub5
- Michie, S. , Richardson, M. , Johnston, M. , Abraham, C. , Francis, J. , Hardeman, W. , .. Wood, C.E. (2013). The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine, 46(1), 81–95. 10.1007/s12160-013-9486-6
- Moher, D. , Hopewell, S. , Schulz, K. F. , Montori, V. , Gøtzsche, P. C. , Devereaux, P. J. , … CONSORT (2012). CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomised trials. International Journal of Surgery, 10(1), 28–55. 10.1016/j.ijsu.2011.10.001
- Pavicic Bosnjak, A. , Rumboldt, M. , Stanojevic, M. , & Dennis, C. L. (2012). Psychometric assessment of the Croatian version of the breastfeeding self‐efficacy scale‐short form. Journal of Human Lactation, 28(4), 565–569. 10.1177/0890334412456240
- Rollins, N. C. , Bhandari, N. , Hajeebhoy, N. , Horton, S. , Lutter, C. K. , Martines, J. C. , … Victora, C. G. (2016). Why invest, and what it will take to improve breastfeeding practices? The lancet, 387(10017), 491–504. 10.1016/s0140-6736(15)01044-2
- UNICEF & WHO (2006). Breastfeeding promotion and support in a baby friendly hospital: A 20 hour course for maternity staff. New York: UNICEF.
- Vaux, A. , Phillips, J. , Holly, L. , Thomson, B. , Williams, D. , & Stewart, D. (1986). The social support appraisals (SS‐A) scale: Studies of reliability and validity. American Journal of Community Psychology, 14(2), 195–218. 10.1007/BF00911821
- Victora, C. G. , Bahl, R. , Barros, A. J. , França, G. V. , Horton, S. , Krasevec, J. , … Rollins, N. C. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475–490. 10.1016/s0140-6736(15)01024-7
- World Health Organization (2001). Global strategy for infant and young child feeding: The optimal duration of exclusive breastfeeding. World Health Organization;
- Zakarija‐Grkovic, I. , Boban, M. , Janković, S. , Ćuže, A. , & Burmaz, T. (2017). Compliance With WHO/UNICEF BFHI Standards in Croatia After Implementation of the BFHI. Journal of Human Lactation, 34(1), 106–115. 10.1177/0890334417703367
- Zakarija‐Grković, I. , Puharić, D. , Malički, M. , & Hoddinott, P. (2016). Breastfeeding booklet and proactive phone calls for increasing exclusive breastfeeding rates: RCT protocol. Maternal & Child Nutrition, 13(1). 10.1111/mcn.12249
- Zakarija‐Grković, I. , Segvic, O. , Bozinovic, T. , Cuze, A. , Lozancic, T. , Vuckovic, A. , & Burmaz, T. (2012). Hospital practices and breastfeeding rates before and after the UNICEF/WHO 20‐hour course for maternity staff. Journal of Human Lactation, 28(3), 389–399. 10.1177/0890334412447079
Source: PubMed